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Health is where the systems meet

Part I describes systems and their couplings. It ranks no country or operator and assesses no authority.

7 min read2 figures1 table20 notesNR-SECTOR-HEALTH-GLOBAL-2026-BASELINE

Contents
  1. ·Edition home
  2. ·Executive summary
  3. 1Health is where the systems meet
    1. 1.1 The questions this part answers
    2. 1.2 The argument
    3. 1.3 Twenty couplings between five systems
  4. 2Key findings
  5. 3Systems and sectors at baseline
  6. 4Risks and capability
  7. 5Outbreak, funding gap and heat season in fragile health systems
  8. 6Readings from the other desks
  9. 7The 2027 agenda
  10. 8Systems in depth
  11. AMethodology
  12. BData appendix
  13. CReferences and record
  14. ·Complete edition, for print

1.1The questions this part answers

Key questions

  • Where is health risk concentrated?
  • Which couplings carry health shocks into other systems?
  • Which health capabilities hold under compound stress?
  • What must 2027 evidence measure first?

In this part

  • Narrative
  • Headline finding
  • Lead figure
  • Five coupling chapters
  • Twelve-domain reading
  • Sector screens
  • Dependency matrix
  • Risk objects
  • Capability ladder
  • Scenario
  • Three lenses
  • Portfolio

1.2The argument

Health is usually reported as a sector: services, diseases, spending. The 2026 evidence reads it as the outcome of almost every other system. Safe water and food, clean air and cooking fuels, stable climate and healthy ecosystems all shape who falls ill and who is treated in time263235.

The long gains are real. The coverage index rose from 54 to 71 since 2000, under-five mortality is less than half its 2000 level and vaccines averted an estimated 59 million measles deaths between 2000 and 20242159. Yet progress has slowed since 2015, and none of the health-related goal indicators with numeric targets is on track21.

Money and people are the binding constraints. Aid for health is estimated at about half its 2021 peak and WHO country offices report service disruption403. The workforce has grown by 52% in density since 2006, yet a shortage of 11.1 million is projected by 203039.

Biological risk is moving at the same time. A large Bundibugyo outbreak is running with no authorised vaccine, resistance to antibiotics is rising and heat deaths are rising561155. Governance is catching up: amended regulations are in force and the Pandemic Agreement awaits its annex2123.

Figure 1.1How large are the leading infectious killers? Deaths in the latest reported year (thousand)

These four diseases cause about 2.5 million deaths a year, and all have effective prevention or treatment. Vaccination and treatment have averted far more: an estimated 59 million measles deaths since 2000 and 83 million TB deaths since 200094. The years differ by series and the bars are shown for scale only.

ItemBar, scaled to the largest valueValue
Tuberculosis, 20241230
Malaria, 2024610
HIV, 2025570
Measles, 202495

Source: as cited in the note to this figure. Year 2024.

Figure ID FIG-SECTOR-HEALTH-GLOBAL-2026-BASELINE-01-003

282million

malaria cases, 20245

41.0million

people living with HIV, 20257

10.7million

people who fell ill with TB, 20244

2 in 5people

with drug-resistant TB who accessed treatment, 20244

1.3Twenty couplings between five systems

The health-centred matrix types the twenty couplings between the five core systems, read for their health content. Strengths are Nexus estimates (ESTIMATED) from the cited evidence and analogue events; they set the graph that 2027 evidence will test.

Figure 1.2Couplings between the five systems

Each line is one coupling from one system to another, drawn by the strength the edition assigns. Strengths are Nexus estimates from the cited evidence and analogue events.

  • Strong
  • Moderate
  • Weak

Source: this edition’s coupling matrix (Table 1.1); status Estimated.

Table 1.1Coupling matrix: from the row system to the column system
From, toWATENEFOOHLTBIO
WAT Water·WEAK
hydropower for facilities		MODERATE
irrigation · food safety		STRONG
cholera · hygiene · treatment		MODERATE
catchments · pathogens
ENE EnergyWEAK
pumping		·MODERATE
cold chain · processing		STRONG
clean cooking · clinic power		WEAK
mining · land use
FOO FoodWEAK
withdrawals		WEAK
bioenergy		·STRONG
nutrition · foodborne illness		MODERATE
land use · livestock
HLT HealthWEAK
effluent · residues		WEAK
facility demand		MODERATE
labour · food-chain workers		·MODERATE
antimicrobial residues · spillback
BIO BiodiversityMODERATE
catchment condition		WEAK
biomass		MODERATE
pests · animal disease		STRONG
zoonoses · vectors		·
Strength: strong, moderate or weak; a Nexus estimate (status Estimated) from cited evidence and analogue events. The scale is defined in Annex A.

Transmission paths

  1. 01

    WAT → HLT

    Unsafe water and poor sanitation spread cholera and other diarrhoeal disease.

    Reported 2025 cholera deaths, highest since 199935

  2. 02

    BIO → HLT

    Spillover from animals starts outbreaks that health systems must absorb.

    Reported 2026 Bundibugyo outbreak5617

  3. 03

    CLI → HLT

    Heat raises deaths and harms pregnancy and childhood.

    Reported about 546 000 heat deaths a year5530

  4. 04

    FIN → HLT

    Aid reductions disrupt services and raise out-of-pocket costs.

    Reported 2025 country office reports340

  5. 05

    ENE → HLT

    Polluting cooking fuels cause household air pollution deaths.

    Reported 2021 estimate26

Notes

Numbers are the edition’s reference numbers, so a note reads the same in every chapter. The full list, with every source and its licence, is in Annex C. Annex C, references

  1. 26WHO (ed.), Household air pollution and health, fact sheet (16 December 2025). World Health Organization, Geneva. Observation year 2021. Accessed 2026-11-03.back
  2. 32WHO (ed.), Food safety, fact sheet (4 June 2026). World Health Organization, Geneva. Observation year 2021. Accessed 2026-11-03.back
  3. 35WHO (ed.), WHO reports latest global trends in cholera, meningitis and plague, news release (29 September 2026). World Health Organization, Geneva. Observation year 2025. Accessed 2026-11-03.back
  4. 2WHO (ed.), Universal health coverage (UHC), fact sheet (5 December 2025). World Health Organization, Geneva. Observation year 2023 (service coverage) and 2022 (financial hardship). Accessed 2026-11-03.back
  5. 15WHO (ed.), Child mortality (under 5 years), fact sheet (1 May 2026). World Health Organization, Geneva. Observation year 2024. Accessed 2026-11-03.back
  6. 9WHO (ed.), Measles, fact sheet (15 July 2026). World Health Organization, Geneva. Observation year 2024 (deaths) and 2025 (coverage). Accessed 2026-11-03.back
  7. 1WHO (ed.), World Health Statistics 2026: A visual summary and report page (monitoring health for the SDGs, 13 May 2026). World Health Organization, Geneva. Observation year 2023 (deaths and life expectancy). Accessed 2026-11-03.back
  8. 40Apeagyei, A.E. et al., Tracking development assistance for health, 1990 to 2030: historical trends, recent cuts, and outlook, The Lancet, 2025; abstract read through Europe PMC. Institute for Health Metrics and Evaluation, Seattle. Observation year 2025 (estimate). Accessed 2026-11-03.back
  9. 3UN DESA Statistics Division (ed.), The Sustainable Development Goals Report 2026, Goal 3 storyline, Good health and well-being. United Nations, New York. Observation year 2024. Accessed 2026-11-03.back
  10. 39POST-CLOSE, context only: WHO (ed.), One in four doctors nearing retirement age as WHO warns of global health workforce gap, news release on National health workforce accounts: health workforce levels and trends 2026 (19 October 2026; released after the 30 September evidence close and cited as the position at access). World Health Organization, Geneva. Observation year 2025. Accessed 2026-11-03.back
  11. 56WHO (ed.), Disease Outbreak News: Ebola disease caused by Bundibugyo virus, Democratic Republic of the Congo (25 September 2026, data to 23 September 2026). World Health Organization, Geneva. Observation year 2026. Accessed 2026-11-03.back
  12. 11WHO (ed.), WHO warns of widespread resistance to common antibiotics worldwide, news release on the Global antibiotic resistance surveillance report 2025 (13 October 2025). World Health Organization, Geneva. Observation year 2023. Accessed 2026-11-03.back
  13. 55WHO (ed.), Climate inaction is claiming millions of lives every year, warns new Lancet Countdown report, news release on the 2025 Lancet Countdown on health and climate change (29 October 2025; the report itself was not opened). World Health Organization, Geneva. Observation year 2025 (average of about 546 000 heat-related deaths a year; the averaging period is not stated in the release). Accessed 2026-11-03.back
  14. 21WHO (ed.), World Health Assembly adopts historic Pandemic Agreement, news release (20 May 2025). World Health Organization, Geneva. Observation year 2025. Accessed 2026-11-03.back
  15. 23WHO (ed.), International Health Regulations: amendments, questions and answers (1 October 2024). World Health Organization, Geneva. Observation year 2024. Accessed 2026-11-03.back
  16. 4WHO (ed.), Tuberculosis, fact sheet (24 March 2026). World Health Organization, Geneva. Observation year 2024. Accessed 2026-11-03.back
  17. 5WHO (ed.), Malaria, fact sheet (4 December 2025). World Health Organization, Geneva. Observation year 2024. Accessed 2026-11-03.back
  18. 7UNAIDS (ed.), Global HIV and AIDS statistics, fact sheet (2026 data release of 27 July 2026). Joint United Nations Programme on HIV/AIDS, Geneva. Observation year 2025. Accessed 2026-11-03.back
  19. 17WHO (ed.), One Health, fact sheet (8 May 2026). World Health Organization, Geneva. Observation year 2026 (current text; the share of emerging infections is undated in the sheet). Accessed 2026-11-03.back
  20. 30POST-CLOSE, context only: WHO, WMO, UNICEF and UNFPA (eds.), New global framework launched to track increasing health risks of extreme heat for pregnant women, newborns and children, news release (21 October 2026; released after the 30 September evidence close and cited as the position at access). World Health Organization, Geneva. Observation year 2024. Accessed 2026-11-03.back

Cite this chapter

Valadbaygi, S. (Ed.). (2026). Chapter 1: Health is where the systems meet. In Global Health Risk and Resilience Report 2026: Baseline Edition, The State of the World’s Health and One Health System. (Baseline Edition 2026, Report No. NR-SECTOR-HEALTH-GLOBAL-2026-BASELINE) [Draft under review]. The Global Centre for Risk and Innovation (GCRI).

Every citation form of the whole report, BibTeX and RIS included, is on the edition home. Cite this report

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Sector signature

The sectors behind Global Health and One Health.

A reading aid: the sectors the findings run through and how strongly they depend on each other.

Select corners · hover lines6 / 15 relations

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Health and its partners

Health gives workforce for operations to infrastructure (0.3), farm labour to food (0.3) and utility workforce to water (0.2).

W · E · I · F · H · B

Sectors
4 of 6
Relations
6 of 15
Coupling
0.42 share of total

Strongest relations in play

  • Water → Food · irrigation0.8
  • Food → Health · nutrition0.7
  • Infrastructure → Water · pipes, dams and treatment works0.6
  • Water → Health · drinking water and sanitation0.7
Teaching values for a typical city-region, not measurements for any place. Coupling is the summed strength of the relations in play, as a share of all fifteen.
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